Percutaneous angioplasty has been the procedure of choice for one- or two-vessel coronary artery disease because it is less invasive than open heart surgery. Video-assisted coronary artery bypass surgery, using the internal mammary artery, may be an alternative method which is also less invasive than conventional open heart surgery. A technique of video-assisted coronary bypass surgery is described. A limited incision is performed in the 4. intercostal space. The left anterior descending artery is pictured and inspected. A 30 degrees thoracoscope is introduced through a separate incision lateral to the thoracotomy. The dissection is performed and the cauterising instrument introduced through the thoracotomy. The anastomotic procedure is performed while the heart is beating and without extracorporeal circulation. The heart rate may be slowed down by administering a betablocking agent. The patient is extubated in the early postoperative period and mobilized in the same way as after conventional coronary artery bypass surgery.